VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

Are Virtual Health Visits Appropriate for Your Patient? An algorithm to support clinical service delivery using virtual services and technology

The development of this document was led by Jonathan Wong, Jennifer Krempien, and Stephanie Hannam-Clark with significant contributions from Erik Skarsgard, Stephanie Rhone, Francine Tessier, Mumtaz Virji, Tom McLaughlin, and Susan Baer.

Additional feedback and review was provided by: Norna Waters (Director, Risk Management), Felicia Laing (Director, Quality, Patient Safety & Accreditation)

This work was supported by a Health Systems Redesign grant through the Specialist Services Committee, Doctors of BC.

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VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

PurposeThis document presents a decision supporting framework with an algorithm and key considerations for determining whether a patient encounter is appropriate for a virtual visit. This framework is intended to guide program leaders to adapt and adopt a core set principles and considerations for the uniqueness of the patients and clinical requirements within a specialty area.

Background Virtual Health refers to a patient centred model focused on connecting patients, families and providers, using technology to optimize wellness, specialty care and outcomes1. Technology used to provide virtual health services may include telephone calls, virtual health visits using a video conference application such as Zoom for Virtual Health Visits, and/or Telehealth services (room based video conferencing).

The use of virtual health services to provide care dramatically increased at BC Children’s Hospital and BC Women’s Hospital + Health Centre (C&W) in response to COVID-19. This transformational shift in how care is provided required providers, allied health clinicians, and clerical staff to quickly pivot and adapt. As we work to stabilize and sustain virtual health services across C&W a need was identified to guide how programs, providers, and clinicians can apply a consistent set of principles to determine the situations that are most appropriate for virtual health services.

1 Provincial Health Services Authority. Virtual Health Policy. VH 100. Published October 22, 2018. Accessed on January 19, 2021.Document # Published Date: dd-Mon-YyyyPage 2 of 8 Review Date: dd-Mon-Yyyy

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VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHMP0

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The use of virtual health has

significantly increased and will

continue to be used in clinical care at C&W.

VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

Guiding Principles of Virtual Health2

Guiding principles provide a reference point to support planning and decision making for C&W leaders, clinicians, providers, staff, and stakeholders to continue the integration and expanded use of virtual health solutions.

1. Care needs guide virtual health planning. Maintaining a high quality of care for our patients is the focus of our efforts to develop and implement virtual health. Virtual health is one modality in how we deliver care.

2. Virtual health services will be planned and delivered in a culturally safe and trauma-informed manner.

3. The British Columbia Health Quality Matrix3 dimensions of quality (respect, safety, accessibility, appropriateness, effectiveness, equity and efficiency) are used to plan and evaluate virtual health services.

4. Virtual health solutions are integral to the service we provide. The integration of virtual health solutions will continue to be enhanced and expanded and will become part of our standard.

5. There are circumstances when virtual health visits are not appropriate. Programs, providers, and patients will work collaboratively to assess the clinical care needs, operational and logistical needs, and patient acceptability to determine if an in-person or virtual visit is more appropriate.4

6. Virtual health solutions will have a sustainment plan to manage any impacts to human resources and/or operational demands prior to implementation. Evaluation of virtual health solutions from a health economics perspective is important to identify health system impacts and efficiencies.

7. Requirements and workflows are assessed prior to selecting and implementing any virtual health solution, application or equipment.

8. Tools that are intuitive to use are often best suited to provide quality care.

9. Virtual health solutions, devices and processes will meet the standards for privacy and security.

10. Innovative and prototype solutions will be tested and evaluated in a structured and thoughtful manner. There will be clear processes to assess technologies and facilitate innovation.

11. Enterprise virtual health solutions, supported by the Office of Virtual Health, will be selected where possible for use across the campus or multiple programs. Interoperability is an important criteria in the selection of enterprise solutions.

12. All providers, medical staff and programs using virtual health will have the endorsement of the appropriate operational and/or executive leader prior to implementing or expanding scope.

13. Implementation of virtual health solutions will consider resources and strategies such as champions, change management, education and transformation strategies required to be successful.

2 Guiding Principles version 1.0, 2021.04.13. Endorsed by the CW Virtual Health Advisory Committee.3 BC Patient Safety & Quality Council. British Columbia Health Quality Matrix. 2020. Accessed on February 10, 2021.4 Are Virtual Health Visits Appropriate for your Patient? An algorithm to support clinical service delivery using virtual services and technology. Document # Published Date: dd-Mon-YyyyPage 4 of 8 Review Date: dd-Mon-Yyyy

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VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

14. Organizational standards for key workflows such as patient consent, confidentiality, maintaining privacy, clinical documentation and information sharing will be documented and followed.

15. Virtual health encounters are captured in Cerner and other information systems accurately and consistently to support evaluation using key metrics.

16. Delivering care virtually requires staff, clinicians, and providers to adjust how they work and be open to continued learning and skill development. We are committed to learning, supporting learners and continuous improvement.

17. Virtual health solutions evolve rapidly and we understand change will be often as we work together to adapt, adopt, and improve for our staff, and most importantly, for the patients, families, and clients we serve.

How to Use This Document

Each program has unique needs based on their clinical population and the services delivered.

Providers, allied health and the clerical team can use the guiding questions to help determine whether a virtual health visit is appropriate based on:

1) Whether the clinical care needs can be met via virtual health.2) Whether clinical services can be delivered via virtual health.3) Whether the patient/family is able to adequetly engage in virtual health.

The decision prompts and guiding questions in the algorithm may require assessment of the patient’s clinical care needs or unique health situation. In general, this assessment should be performed by a provider or clinician to determine the type of visit.

Programs should also consider using virtual health visits as a tool for triaging new referrals and for follow-up encounters to assess the best modality of visit, virtual or in-person, for any subsequent interactions. For example, one approach may be to consider all patients as candidates for virtual health visits and then by applying this framework, decide who would be best served through an in-person visit.

There may be circumstances where a combination of modalities is required. The initial visit may be done via virtual health and the next visit may be better suited to an in person visit.

This decision framework is intended to support programs to develop more specific guidelines and workflows for their areas of practice. This framework should also be taken in consideration of external factors such as public health orders, pandemic, and emergency response restrictions. There may be external influences such as the COVID-19 pandemic or emergency situations where a virtual health visit may be offered to provide some limited aspects of care, when in-person care is restricted or not possible.

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VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

Algorithm - Virtual Clinical Service Delivery Decision Framework

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VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

Additional Resources

1. Canadian Medical Association - Virtual Care Playbook March 2020This is a playbook written to help Canadian physicians introduce virtual patient encounters into practice. The playbook covers key considerations to succeed at providing safe, effective and efficient care

College of Physicians and Surgeons of British Columbia - Telemedicine Practice Standard April 1, 2020

This is the minimum requirements and standards set by the College for physicians to treat patients via telemedicine.

2. Canadian Medical Protective Association – Providing Virtual Care during COVID-19The CMPA website provides information on the medico-legal considerations when delivering care virtually. CMPA offers many additional resources including a podcast on virtual care and additional information on medico-legal issues.

3. Doctors of BCThe Doctors of BC website has several different resources including virtual care guides and toolkits, learning series, webinars and a support network.

4. Office of Virtual Health Resources The Office of Virtual Health has a variety of practical quick reference guides for using Zoom for Health Care and delivering care virtually. This includes the OVH COVID-19 Toolkit and specific resources for Zoom for Virtual Health Visits. Information and resources are added and updated regularly.

5. Related PHSA, BC Children’s Hospital, and BC Women’s Hospital + Health Centre Policy or Procedure Documents

1. Provincial Health Services Authority. Virtual Health Policy. VH 100. Approved October 22, 2018. Accessed on January 19, 2021.

2. Standard: Virtual Health: Standards of practice for the provision of virtual care. Approved September 1, 2020. Accessed from www.policyandorders.cw.bc.ca, January 19, 2021.

3. Standard Work: Health care professional – patient identification and confirming consent for virtual assessment or treatment session. Approved September 1, 2020. Accessed from www.policyandorders.cw.bc.ca, January 19, 2021.

As other documents and resources are developed, this document may be amended to include those resources. Providers are encouraged to review information and resources developed by key agencies and PHSA departments.

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN04-May-2021

C-0506-01-61043 Virtual Health Service Delivery Framework

Approved at: CW Best Practice Committee

DisclaimerThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.  This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA. C-0506-01-61043 Published Date: 12-May-2021Page 7 of 8 Review Date: 12-May-2024

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VIRTUAL HEALTH SERVICE DELIVERY FRAMEWORK

DOCUMENT TYPE: ALGORITHM

Document # Published Date: dd-Mon-YyyyPage 8 of 8 Review Date: dd-Mon-Yyyy

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.